Benson v. Casa De Capri Enterprises LLC

CourtDistrict Court, D. Arizona
DecidedDecember 10, 2024
Docket2:18-cv-00006
StatusUnknown

This text of Benson v. Casa De Capri Enterprises LLC (Benson v. Casa De Capri Enterprises LLC) is published on Counsel Stack Legal Research, covering District Court, D. Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Benson v. Casa De Capri Enterprises LLC, (D. Ariz. 2024).

Opinion

1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA

9 Jacob Benson, et al., No. CV-18-00006-PHX-DWL

10 Plaintiffs, ORDER

11 v.

12 Casa De Capri Enterprises LLC, et al.,

13 Defendants. 14 15 Jacob Benson is a disabled vulnerable adult who received skilled nursing care at a 16 now-defunct facility called Casa de Capri Enterprises LLC (“Capri”). In December 2012, 17 Benson and other family members (together, “Plaintiffs”) brought a negligence action 18 against Capri in Arizona state court. 19 At the time, Capri had a “claims paid” insurance policy issued by Defendant 20 Continuing Care Risk Retention Group, Inc. (“CCRRG”). Under this unusual type of 21 policy, the insurer is only responsible for indemnifying the insured against claims that 22 become payable while the policy remains in effect. In contrast, under an “occurrence” 23 policy or a “claims made” policy (which are more common), the insurer becomes 24 responsible for indemnification so long as the liability-generating event occurred (or was 25 disclosed to the insurer) during the policy term. 26 CCRRG initially assumed the defense of Plaintiffs’ lawsuit against Capri pursuant 27 to Capri’s insurance policy. However, after Capri became insolvent, stopped paying its 28 premiums, declared bankruptcy, and cancelled the policy, CCRRG withdrew the defense. 1 Years later, after the bankruptcy stay was lifted, Plaintiffs obtained a $1.5 million judgment 2 against Capri and initiated this garnishment action against CCRRG. 3 In February 2023, following years of complicated litigation, the Court issued a 4 lengthy order resolving the parties’ cross-motions for summary judgment, holding that 5 CCRRG had no duty under the relevant insurance policies to indemnify Capri for the 6 judgment. (Doc. 149.) The Court also noted that it was unclear whether the summary 7 judgment ruling was sufficient to fully dispose of the case, given that Plaintiffs had asserted 8 during oral argument that they “also seek to recover under the theory that CCRRG breached 9 its duty to defend Capri in the underlying lawsuit.” (Id. at 15 n.4.) After receiving 10 supplemental briefs (Docs. 156, 157), the Court concluded that Plaintiffs adequately 11 disclosed their intention to pursue relief under a duty-to-defend theory. (Doc. 159.) 12 Because the supplemental briefs did not fully address the merits of that theory, the Court 13 authorized the parties to file a second round of summary judgment motions. (Id.) 14 The parties have now done so. (Docs. 160, 162.) For the reasons that follow, 15 CCRRG’s motion is granted and Plaintiffs’ motion is denied. 16 BACKGROUND 17 I. Facts 18 The facts summarized below, and detailed throughout this order, are taken from the 19 parties’ summary judgment submissions and other documents in the record. The facts are 20 uncontroverted unless otherwise noted. 21 On December 10, 2012, Plaintiffs filed suit in Maricopa County Superior Court 22 against Capri, alleging abuse and neglect of a vulnerable adult and negligence. (Doc. 65 23 ¶ 1.) At the time the lawsuit was served, Capri was insured under a “professional liability 24 insurance policy” issued by CCRRG. (Id. ¶ 3.) The policy (the “2012 Policy”) provided 25 coverage from January 1, 2012 to January 1, 2013 and had a policy limit of $1 million. 26 (Doc. 56-1 at 36.) Capri renewed its policy with CCRRG the following year (the “2013 27 Policy”). (Doc. 65 ¶ 4.) The 2013 Policy provided coverage from January 1, 2013 to 28 January 1, 2014. (Doc. 13-1 at 5.) Both policies incorporate by reference a 2009 1 subscription agreement (Doc. 13-1 at 53-73) and CCRRG’s member bylaws (Doc. 65-4). 2 (Doc. 13-1 at 6 [2013 Policy]; Doc. 56-1 at 37 [2012 Policy].) 3 The 2012 and 2013 Policies are “claims paid” policies. (Doc. 132 ¶ 1.) In the 4 “Coverages” section of each Policy, under the subheading “Insuring Agreement,” CCRRG 5 agreed to pay “amounts within the policy limits for ‘Damages,’ [and] ‘Cost of 6 Defense’ . . . on behalf of a ‘Member’ who becomes legally obligated to ‘Pay’ ‘Damages’ 7 and ‘Cost of Defense’ during the time they are a CCRRG ‘Member.’” (Doc. 13-1 at 13, 8 emphasis added.) In the subscription agreement, CCRRG elaborated that “[t]he terms and 9 conditions of this type of coverage differ significantly from a typical occurrence or claims 10 made indemnification insurance policy. In essence, . . . CCRRG has no responsibility for 11 any portion of a claim not actually paid during the contract period.” (Id. at 58.) 12 On its website and in a brochure, CCRRG further addressed this policy language, 13 stating that “[t]he average carrier collects higher premiums to protect itself in advance from 14 the possibility you will change carriers, because their obligation to pay claims persist even 15 after you leave. With [CCRRG], your claims are paid for by the group as long as you are 16 a member. If you have an open claim and decide to leave [CCRRG], the group stops 17 supporting the claim so your claim moves with you.” (Doc. 164 ¶ 20.) Similarly, in a 18 checklist concerning the renewal of coverage, CCRRG explained: “The result of [a ‘claims 19 paid’ policy] is that Members pay less on average from year to year. In return for typically 20 lower premium costs, the Member agrees either to remain with CCRRG until any pending 21 claim is resolved or has the option to purchase an extended reporting period (ERP) 22 coverage when they leave CCRRG. If a Member leaves CCRRG with an open claim and 23 does not purchase ERP then the departing member is thus making the election to take the 24 claim with them and handle defense and payment of indemnity out of their ‘own pocket.’” 25 (Doc. 65-2, emphasis added.)1 26 At the time the Policies were issued, CCRRG was domiciled in South Carolina. 27 (Doc. 164 ¶ 10.) The South Carolina Department of Insurance approved the CCRRG 28 1 Plaintiffs dispute that Capri ever received this document. (Doc. 167 at 4 n.1.) 1 “claims paid” policy form. (Id. ¶ 11.) Gregory Anderson served as Capri’s President and 2 CEO from 2008 through September 2013, when it ceased ongoing operations. (Doc. 56-9 3 ¶¶ 5, 15.) Before 2008, William Fay was Capri’s “managing member.” (Doc. 132-2 ¶¶ 1- 4 5.) Other relevant entities and individuals include Magnolia LTC Management Services 5 (“Magnolia”), which served as the program manager for CCRRG, and Robert “Bob” Bates, 6 who was Magnolia’s president and CCRRG’s corporate secretary. (Doc. 65 ¶ 13.) 7 On December 28, 2012, Capri was served in the Arizona state court lawsuit. (Doc. 8 65 ¶ 2.) It is undisputed that Capri timely reported the lawsuit to CCRRG, as it was 9 required to do under the 2012 Policy. (Id. ¶ 20.) It is also undisputed that CCRRG accepted 10 Capri’s tender under the 2012 Policy and appointed defense counsel to defend the lawsuit 11 without a written reservation of rights. (Id. ¶¶ 21, 23.) 12 Regarding CCRRG’s duty to defend, the 2012 Policy states: “Our right and duty to 13 defend ends when we have exhausted the applicable limit of insurance by the payment of 14 ‘Cost of Defense’ . . . under this Policy or, when this policy is cancelled or not renewed for 15 any reason, provided however, in the event CCRRG is paying ‘Cost of Defense’ . . . 16 CCRRG shall continue to pay ‘Cost of Defense’ . . . for all such ‘Claims’ for a period of 17 time not to exceed thirty (30) days to enable such former ‘Member’ to assume its own legal 18 defense.” (Doc. 56-1 at 2.) The relevant language in the 2013 Policy is identical. (Doc. 19 13-1 at 13.) The subscription agreement further elaborates that: 20 In the event a CCRRG Member fails to pay any Assessment or Dues, Premiums or any payment required by the CCRRG agreement for deferred 21 payment of Surplus when the same is due . . . CCRRG may terminate such member’s Membership status if the failure to pay is not cured within ten (10) 22 days . . . .

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Benson v. Casa De Capri Enterprises LLC, Counsel Stack Legal Research, https://law.counselstack.com/opinion/benson-v-casa-de-capri-enterprises-llc-azd-2024.